Provider Demographics
NPI:1285837047
Name:THE PARK ON 7TH AVENUE
Entity Type:Organization
Organization Name:THE PARK ON 7TH AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MANAGER
Authorized Official - Phone:928-442-3059
Mailing Address - Street 1:10234 N. 7TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2423
Mailing Address - Country:US
Mailing Address - Phone:602-371-0767
Mailing Address - Fax:602-944-2871
Practice Address - Street 1:10234 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2423
Practice Address - Country:US
Practice Address - Phone:602-371-0767
Practice Address - Fax:602-944-2871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINGLETREE INVESTMENTS L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ881616310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility